Day General Hospital, Tehran, Iran.
Ann Thorac Surg. 2010 Aug;90(2):497-502. doi: 10.1016/j.athoracsur.2010.04.060.
The aim of this study was to investigate the feasibility of performing papillary muscle repositioning (PMR) for subvalvular-sparing mitral valve replacement procedures in patients with ischemic mitral regurgitation and to determine the early and late effects of this procedure on the clinical outcome and left ventricular mechanics.
We prospectively randomly allocated 50 patients with severe ischemic mitral regurgitation and left ventricle dysfunction who were candidates for coronary artery bypass graft surgery and mitral valve replacement into a total chordal-sparing mitral valve replacement group or a PMR group. Echocardiography was performed preoperatively, at discharge, and after 3 years to determine the left ventricular dimensions, shape, and function.
The reduction in the left ventricle volumes and sphericity index in the PMR group was more significant than that in the other group. With regard to the left ventricular end-systolic and left ventricular end-diastolic volumes, sphericity index, and ejection fraction, the PMR group showed better results (p < 0.05), but the difference in New York Heart Association functional class after 3 years was not statistically significant between the two groups (p > 0.05).
The PMR technique described herein can dramatically help ischemic patients by affecting the left ventricular shape and function more efficiently compared with the complete retention of the mitral subvalvular apparatus if the mitral valve is to be replaced.
本研究旨在探讨在缺血性二尖瓣反流患者中进行瓣下保留二尖瓣置换术时行乳头肌重定位（PMR）的可行性，并确定该术式对临床结果和左心室力学的早期和晚期影响。
我们前瞻性地随机将 50 例严重缺血性二尖瓣反流和左心室功能障碍、适合行冠状动脉旁路移植术和二尖瓣置换术的患者分为完全保留腱索的二尖瓣置换组或 PMR 组。术前、出院时和 3 年后进行超声心动图检查，以确定左心室的大小、形状和功能。
PMR 组左心室容积和球形指数的减小更为显著。在左心室收缩末期和舒张末期容积、球形指数和射血分数方面，PMR 组的结果更好（p < 0.05），但 3 年后两组纽约心脏协会心功能分级的差异无统计学意义（p > 0.05）。
如果需要置换二尖瓣，与完全保留二尖瓣瓣下装置相比，PMR 技术可以通过更有效地影响左心室的形状和功能，显著改善缺血性患者的状况。
